Moral Status and Personhood in MCS and PVS

Introduction

Moral Status and Personhood

To matter morally is “to bear direct or independent moral importance.” (DeGrazia 2008) Discussions around moral status are often related to welfare or interests such as the moral status of animals in scientific research or that of a fetus during gestation. Moral status grants rights or at least specific interests to a given entity and results in corresponding obligations being owed to said entity.

Personhood is central to many bioethics debates and controversies, it also serves as the theoretical and normative underpinning to the principle of respect for persons.

In the philosophical bioethics literature, “persons are those entities who possess a particular moral status and about whom particular moral claims may be made on the basis of that status.”  (Chan & Harris 2011). While personhood is not necessary to attribute moral status to an individual or entity, moral persons are understood to have full moral status and the corresponding rights and duties attached to it.

What are DOCs?

A disorder of consciousness (DOC) is a state of prolonged altered consciousness that can result from damage to the brain caused by traumatic or non traumatic injury.  Consciousness is characterized by both wakefulness and awareness. Wakefulness accounts for the ability to open eyes and carry out basic reflexes like coughing or sneezing. Awareness involves higher functions and more complex thought processes. Types of disorders of consciousness can range from coma, to minimal consciousness, to vegetative state.  (Eapen et al 2017; NHS 2018; Braddock 2017).

Minimally conscious state

MCS patients demonstrate intermittent and irregular behavioral signs of conscious awareness. Because of the prevalence of signs in patients MCS can be subcategorized into MCS+ and MCS– depending on the complexity of the behavioral response. (Braddock 2017, Bruno et al 2011).

Persistent vegetative state

PVS patients are in a situation known as unresponsive wakeful unconsciousness. While they have sleep and waking patterns they do not respond to any stimuli and exhibit no behavioral signs (Braddock 2017). In the USA persistent vegetative state becomes permanent if it lasts longer than three months after a non traumatic injury, or more than twelve months after a traumatic brain injury (Multi Society Task Force 1994).

Bioethics and DOCs

The treatment, allocation of resources and rights of patients in PVS or MCS depend on how we  understand their situation and attribute them moral status and/or personhood. Therefore, better diagnostic methods, criteria, and rigorous normative analysis can help improve the standard of care of all patients across the board.

Assigned Reading

The following paper was used to inform and ground the discussion:

Braddock, M. (2017). Should We Treat Vegetative and Minimally Conscious Patients as Persons?. Neuroethics 10, 267–280. https://doi.org/10.1007/s12152-017-9309-8

Thesis: In the light of the mounting evidence on the uncertainty of PVS diagnoses Braddocks revisits common assumptions and criteria used to evaluate persistent vegetative and minimally conscious states. He develops a guiding principle of Precautionary Personhood to argue that given the substantial uncertainty PVS and MCS patients should be treated as persons.

Click here for an infographic outline of Braddock’s arguments on personhood and disorders of consciousnessDownload

Discussion Questions

The following questions were considered by seminar participants prior to the discussion.

  1. Braddock lays out several arguments for why we should treat patients in a VS or MCS as “having the full moral status of persons.” [see infographic linked above for summary] Which arguments in the paper did you find to be strong or convincing? (conclusion supported by premises? Premises true?)Which arguments in the paper did you find to be weak or problematic (conclusion not supported by premise? Premises subject to counter-examples or objections)? 
  2. How can we ground the arguments or debate in broader ethical theories?
  3. What are the implications of the concepts of moral status and personhood in other bioethics debates?

Reflection Points

  1. What are the implications of the Principle of Precautionary Principle? Can it be applied to cases beyond DoCs, ie cerebral organoids, AI, or nonhuman animals?
  2. What is there a need for so much conceptual work on moral status and personhood?
  3. In what ways does the Principle of Precautionary Personhood conflict with a principle for precautionary quality of life?

References & Additional Resources

DeGrazia, D. (2008). Moral Status As a Matter of Degree? The Southern Journal of Philosophy, 46: 181-198. https://doi.org/10.1111/j.2041-6962.2008.tb00075.x

Chan, S., & Harris, J. (2011). Human Animals and Non-Human Persons. In T. L. Beauchamp, & R. G. Frey (Eds.), The Oxford Handbook of Animal Ethics (pp. 304-331 ). Oxford University Press. https://doi.org/10.1093/oxfordhb/9780195371963.013.0012

Willmott, L. & White, B. (2017). Persistent vegetative state and minimally conscious state: ethical, legal and practical dilemmas. Journal of Medical Ethics. 43:425-426.

Foster, C. (2019). It is never lawful or ethical to withdraw life-sustaining treatment from patients with prolonged disorders of consciousness. Journal of Medical Ethics. 45:265-270.